1.UnderstandingHowLEPIndividualsInteractwithYourAgency ThefollowingseriesofquestionshelpsagenciesunderstandhowanLEPindividualmaycome intocontactwithyouragency: 1.Doesyouragencyinteractor ___Yes ___No communicatewiththepublicorare thereindividualsinyouragencywho interactorcommunicateormight interactorcommunicatewithLEP individuals? 2.

.Pleasedescribethemannerinwhich ___Inperson ___Viacorrespondence youragencyinteractswiththepublicor ___Telephonically ___Other: LEPindividuals: ___Electronically(e.g., _____________________ viaemailorwebsite) 3.Doesyouragencyprovidefederal ___Yes ___No financialassistancetoanynonfederal entities?(Federalfinancialassistance includesgrants,training,useof equipment,donationsofsurplus property,andotherassistance. Recipientsoffederalfundscanrange fromstateandlocalagencies,to nonprofitsandotherorganizations.) 4.Ifyouragencydoesprovidefederal financialassistancetononfederal entities: a.Doyouhaveanactiveprogramin placetorequireyourrecipientsof federalfinancialassistancetocomply withTitleVIandlanguageaccess standards? b.Doesyouragencyinformrecipientsof federalfinancialassistancethatthey shouldbudgetforlanguageassistance services? c.Doesyouragencyinformrecipientsof federalfinancialassistanceaboutwhich grantscanbeused,inwholeorinpart, toimprovelanguageaccess?

LANGUAGEACCESSSELFASSESSMENT

2.IdentificationandAssessmentofLEPCommunities ThefollowingseriesofquestionsaimstoidentifytheLEPpopulationyouserve: 1.HowdoesyouragencyidentifyLEP ___AssumeLEPif ___UseofISpeak individuals?(Selectallthatapply) communicationseems languageidentification impaired cards ___Respondtoindividual ___Basedonwritten requestsforlanguage materialsubmittedto assistanceservices theagency(e.g., ___Selfidentificationby complaints) nonEnglish/LEPspeaker ___Wehavenot ___Askopenended identifiednonEnglish questionstodetermine speakers/LEPindividuals languageproficiencyon ___Other(Pleasespecify) thephoneorinperson ___________________ 2.Doesyourprogramhaveaprocessto ___Yes ___No collectdataon: a.ThenumberofLEPindividualsthat ___Yes ___No youserve? b.ThenumberofLEPindividualsinyour ___Yes ___No servicearea? c.Thenumberandprevalenceof ___Yes ___No languagesspokenbyLEPindividualsin yourservicearea? 3.Howoftendoesyouragencyassess ___Annually ___Notsure thelanguagedataforyourservicearea? ___Biennially ___Other:___________ 4.Whatdatadoesyouragencyuseto ___Census ___Community determinetheLEPcommunitiesinyour ___USDeptofEducation organizations servicearea?(Selectallthatapply) ___USDept.ofLabor ___Intakeinformation ___StateAgencies ___Other:____________ 5.Doyoucollectandrecordprimary ___Yes ___No languagedatafromindividualswhen theyfirstcontactyourprogramsand activities? 6.Ifyoucollectandrecordprimary languagedata,whereistheinformation stored? 7.WhatisthetotalnumberofLEP individualswhouseorreceiveservices fromyourprogrameachyear? 8.HowmanyLEPindividualsattemptto accessyourprogramsorserviceseach month?

9.HowmanyLEPindividualsuseyour programsorserviceseachmonth? 10.Specifythetopsixmostfrequently encounterednonEnglishlanguagesby yourprogramandhowoftenthese encountersoccur(e.g.,23timesayear, onceamonth,onceaweek,daily, constantly).

Language: 1.________________ 2.________________ 3.________________ 4.________________ 5.________________ 6.________________

Encounterfrequency: 1.________________ 2.________________ 3.________________ 4.________________ 5.________________ 6.________________

3.ProvidingLanguageAssistanceServices Thefollowingsetofquestionswillhelpyouassesshowwellyouragencyisprovidinglanguage assistanceservicestoLEPindividuals: 1.Doesyouragencycurrentlyhavea ___Yes ___No systeminplacefortrackingthetypeof languageassistanceservicesitprovides toLEPindividualsateachinteraction? 2.Whatdata,ifany,doyoumaintain ___Primarylanguageof ___Numberofbilingual regardinglanguageassistanceservices? persons staff (Selectallthatapply) encountered/served ___Costofinterpreter ___Useoflanguage services assistanceservicessuch ___Costoftranslationof asinterpretersand materialsintonon translators Englishlanguages ___Fundsorstafftime ___Other(Please spentonlanguage specify):_______ assistanceservices 3.Doesyouragencyhaveasystemto ___Yes ___No trackthecostoflanguageassistance services? 4.Whattypesoflanguageassistance ___Bilingualstaff ___Languagebankor servicesdoesyouragencyprovide? ___Inhouseinterpreters dedicatedpoolof (Selectallthatapply) ___Inhousetranslators interpreters/ (Note:Interpreters=oral,translators= ___Contractinterpreters translators writtendocuments) ___Phoneinterpretation ___Volunteer services interpretersor ___Videointerpretation translators services ___Interpretersor translators borrowedfrom anotheragency ___Other:

5.(a)Doesyouragencyhavea certificationorassessmentprocessthat staffmustcompletebeforeservingas interpretersortranslatorsforLEP individuals? (b)Doestheprocessincludeuseof standardizedlanguageproficiency exams? 6.DoesyouragencyaskorallowLEP individualstoprovidetheirown interpretersorhavefamilymembersor friendsinterpret? 7.Doesyouragencyhavecontractswith languageassistanceserviceproviders (inpersoninterpreters,telephone interpreters,videointerpreters,or translators)? 8.Doesyouragencyprovidestaffwitha listofavailableinterpretersandthe nonEnglishlanguagestheyspeak,or informationonhowtoaccessqualified interpreters? 9.Doesyouragencyidentifyand translatevitaldocumentsintothenon Englishlanguagesofthecommunitiesin yourservicearea? 10.Whichvitalwrittendocumentshas youragencytranslatedintononEnglish languages?

(a)___Yes (b)___Yes ___Yes

(a)___Yes (b)___No ___No

___Yes

___No

___Yes

___No

___Yes

___No

___Consentforms ___Complaintforms ___Intakeforms ___Noticesofrights ___Noticeofdenial,loss ordecreaseinbenefits orservices

11.Doesyouragencytranslatesignsor postersannouncingtheavailabilityof languageassistanceservices? 12.Whenyouragencyupdates informationonitswebsite,doesitalso addthatcontentinnonEnglish languages?

___Yes ___Yes

___Noticeofdisciplinary action ___Applicationsto participateinprograms oractivitiesortoreceive benefitsorservices ___Other(specify): _______ ____________________ ___ ___No ___No

4.TrainingofStaffonPoliciesandProcedures Thefollowingseriesofquestionswillhelpyouidentifywhetherstaffreceiveappropriate trainingonyourlanguageaccesspoliciesandprocedures: 1.Doesallagencystaffreceiveinitial ___Yes ___No andperiodictrainingonhowtoaccess andprovidelanguageassistance servicestoLEPindividuals? 2.Whoreceivesstafftrainingon ___Management/ ___BilingualStaff workingwithLEPindividuals?(Selectall seniorstaff ___Newemployees thatapply) ___Employeeswho ___Allemployees interactwithorare ___Volunteers responsiblefor ___Others(specify): interactionswithnon ___________________ EnglishspeakersorLEP ___Noneoftheabove individuals 3.ArelanguageaccesspoliciesandLEP issuesincludedinthemandatory trainingcurriculumforstaff? 4.Doesyouragencystaffprocedural manualorhandbookincludespecific instructionsrelatedtoproviding languageassistanceservicestoLEP individuals? 5.Doesstaffreceiveperiodictrainingon howtoobtainandworkwith interpreters? 6.Doesstaffreceiveperiodictrainingon howtorequestthetranslationof writtendocumentsintoother languages? 7.Dostaffmemberswhoserveas interpretersreceiveregulartrainingon properinterpretingtechniques,ethics, specializedterminology,andother topics? 8.Dostaffmemberswhoserveas interpretersreceiveinterpretertraining fromcompetentinterpretersorother trainersfamiliarwiththeethicaland professionalrequirementsofan interpreter?

5.ProvidingNoticeofLanguageAssistanceServices Thefollowingseriesofquestionswillhelpyouassesshowyouprovidenoticeoflanguage assistanceservicestotheLEPpopulationinyourservicearea: ___Frontline&outreach ___Socialnetworking 1.Howdoyouinformmembersofthe multilingualstaff website(e.g.,Facebook, publicabouttheavailabilityoflanguage ___Postersinpublicareas Twitter) assistanceservices?(Selectallthat ___ISpeaklanguage ___Emailtoindividualsor apply) identificationcards alistserve distributedtofrontline ___Other(specify): staff ___________________ ___Website ___Noneoftheabove ___No 2.Doyourtranslatedprogramoutreach ___Yes materialsinformLEPindividualsabout theavailabilityoffreelanguage assistanceservices? ___No 3.Doesyouragencyregularlyadvertise ___Yes onnonEnglishmedia(television,radio, newspaper,andwebsites)? ___No 4.Doesyouragencyinformcommunity ___Yes groupsabouttheavailabilityoffree languageassistanceservicesforLEP individuals? ___Yes ___No 5.Doesyouragencyinformcurrent applicantsorrecipientsaboutthe availabilityoflanguageassistance services? ___Yes ___No 6.Doesthemainpageofyouragency websiteincludenonEnglishinformation thatwouldbeeasilyaccessibletoLEP individuals? ___Yes ___No 7.Doesyouragencyhavemultilingual signsorpostersinitsofficesannouncing theavailabilityoflanguageassistance services? 6.MonitoringandUpdatingaLanguageAccessProcedures,Policy,andPlan Thefollowingsetofquestionswillhelpyouassesswhetheryouhaveaneffectiveprocessfor monitoringandupdatingyourlanguageaccesspolicies,planandprocedures: 1. Doesyouragencyhavea ___Yes ___No writtenlanguageaccess policy?

2.Ifso,isadescriptionofthis policyavailabletothepublic? 3.Howoftenisyouragencys languageaccesspolicy reviewedandupdated? 4.Whenwasthelasttime youragencyslanguageaccess policywasupdated? 5.Howoftendoesyour agencyupdateitsdataonthe LEPcommunitiesinyour servicearea? 6.Doesyouragencyhavea languageaccesscoordinator? 7.Doesyouragencyhavea formallanguageaccess complaintprocess? 8.Hasyouragencyreceived anycomplaintsbecauseitdid notprovidelanguage assistanceservices? 9.Doyoumonitorthesystem forcollectingdataon beneficiarysatisfaction and/orgrievance/complaint filing? 10.Doyouobtainfeedback fromtheLEPcommunityon theeffectivenessofyour languageaccessprogramand thelanguageassistance servicesyouprovide?

___Yes ___Annually ___Biennially ___Month ___Annually ___Biennially ___Yes ___Yes ___Yes

___No ___Notsure ___Other:_______________ ___Yes ___Notsure ___Other:_______________ ___No ___No ___No

___Yes

___No

___Yes

___No